title: A pilot study on modified endoscopic variceal ligation using endoscopic ultrasonography with color Doppler function.
abstract: OBJECTIVE
  The purpose of the study was to evaluate feasibility of modified endoscopic variceal ligation (EVL), namely the "intensive ligation" method, using endoscopic ultrasonography with color Doppler function (EUS-CD).
  
  
  METHODS
  Forty-five patients with esophageal varices were treated by modified EVL. Variceal hemodynamics in 38 patients were examined using EUS-CD, which showed abdominal hemodynamics in detail under physiological conditions before and after the modified procedure.
  
  
  RESULTS
  1) The median number of treatment sessions was 3.2, and 41 O-rings on average were required per individual patient. 2) The median nonrecurrence period after treatment was 18 months (Kaplan-Meier method). 3) Nine patients with a good response to modified EVL did not have recurrences for 16.9+/-2.8 months, and five with a poor response had recurrences at 5.8+/-2.2 months. Gastric varices were related to the response to modified EVL (p < 0.05, Mann-Whitney's U test). 4) Minor complications in modified EVL as well as standard EVL were experienced; however, we had a patient with the development of meningitis, which was a major septic complication. 5) Before modified EVL, EUS-CD demonstrated that good responders had undeveloped (grade I) gastric varices in five of nine (56%); however, poor responders had developed (grade III) gastric varices in four of five (80%) (p < 0.05, Mann-Whitney's U test]. 6) After modified EVL, EUS-CD revealed that six of nine (67%) good responders and one of five (20%) poor responders showed a decrease in color signals in supplying veins; however, none of the former (0%) and three of the latter (60%) showed an increase (p < 0.05, Mann-Whitney's U test].
  
  
  CONCLUSIONS
  Modified EVL was safe and effective, at least with regard to intermediate-term outcome, especially when treating patients with undeveloped gastric varices revealed by EUS-CD. Both good and poor responders showed no exacerbation of gastric varices after the modified procedure, ultrasonographically as well as endoscopically.
authors.affiliation: Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Nagamine
authors.forename: N
authors.initials: N
authors.lastname: Ueno
authors.forename: T
authors.initials: T
authors.lastname: Tomiyama
authors.forename: T
authors.initials: T
authors.lastname: Aizawa
authors.forename: S
authors.initials: S
authors.lastname: Tano
authors.forename: S
authors.initials: S
authors.lastname: Wada
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Amagai
authors.forename: K
authors.initials: K
authors.lastname: Ono
authors.forename: Y
authors.initials: Y
authors.lastname: Kumakura
authors.forename: T
authors.initials: T
authors.lastname: Hirasawa
authors.forename: Y
authors.initials: Y
authors.lastname: Ishino
authors.forename: K
authors.initials: K
authors.lastname: Ido
authors.forename: K
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D019160:Endosonography / Q000009:adverse effects; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence; D018615:Ultrasonography, Doppler, Color